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The Oldest Gravidas: A Review of Pregnancy Risks in Women Over 45

Salmeen, Kirsten MD*; Zlatnik, Marya MD

Obstetrical & Gynecological Survey: September 2011 - Volume 66 - Issue 9 - p 580-590
doi: 10.1097/OGX.0b013e318239125b

As a result of delayed childbearing and increasingly sophisticated assisted reproductive technologies, pregnancy in women aged ≥45 years is becoming more common. Women in this age-group should receive thorough preconception evaluation and counseling about their specific risks in pregnancy. Although many pregnancies in women >45 years old are achieved via assisted reproductive technologies with associated preconception counseling, as many as 45% may be spontaneously conceived. It is therefore important for obstetrician-gynecologists to incorporate education for older women about the risks of pregnancy into routine office visits, and to ask women in this age-group about pregnancy planning. Additionally, many pregnancies in women aged >45 years may be safely managed in a nontertiary care center, avoiding the need for referral and transfer of care to an unfamiliar setting. This review addresses preconception evaluation and counseling, real and perceived risks in older mothers, common pregnancy complications and management of pregnancy in women >45 years old.

Target Audience: Obstetricians & Gynecologists, Family Physicians

Learning Objectives: After completion of this article, the reader should be better able to counsel women about the risks of pregnancy for women aged ≥45, evaluate older women for common risk factors that may further increase risk in pregnancy, assess pregnancy complications that are more common in women aged >45, and manage otherwise uncomplicated pregnancies in women in this age-group.

*Fellow, †Associate Professor, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA

Chief Editor's Note: This article is part of a series of continuing education activities in this Journal through which a total of 36 AMA/PRA Category 1 Credits™ can be earned in 2011. Instructions for how CME credits can be earned appear on the last page of the Table of Contents.

The authors, faculty and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interest in, any commercial organizations pertaining to this educational activity.

Correspondence requests to: Kirsten Salmeen, MD, University of California, San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences, 505 Parnassus Ave, Box 0132, San Francisco, CA 94143. E-mail:

© 2011 Lippincott Williams & Wilkins, Inc.